全科医师心身医学服务能力评价指标体系构建的实证研究

Verification of the evaluation index system for ability of general practitioners in psychosomatic medicine service

摘要:

目的 验证“全科医师心身医学服务能力评价指标体系”的信效度，计算指标体系各条目的权重值。方法 采用分层整群抽样方法，在上海市抽取23家社区卫生服务中心的699名全科医师进行问卷调查，验证能力评价指标体系的信度、效度和区分度。邀请25名专家对能力评价指标体系各条目的重要性进行打分，通过层次分析法确定评价权重值。 结果 能力评价指标体系的整体Cronbach’s α系数为0.976；探索性因子分析共提取了3个共同因子，累积方差贡献率为76.929%；采用Amos 21.0统计软件进行模型拟合，残差均方根=0.044、近似误差均方根=0.077、增值拟合指数=0.938、比较拟合指数=0.938、非标准拟合指数=0.932、简约拟合优度指数=0.701、简约规范拟合指数=0.853、简约比较拟合指数=0.847指标均达到评价标准；各因子的平方根值大于该因子与其他因子间的相关系数，表明该指标体系的区分效度较好。一级指标中知识、态度、技能的权重分别为0.454、0.225、0.321。结论 本研究构建的全科医师心身医学服务能力评价指标体系具有较好的信效度，可作为全科医师能力培养、评价和考核的工具。

Abstract:

Objective To verify the reliability and validity of the comprehensive evaluation index system for ability of general practitioners in psychosomatic medicinel service. Methods To verify the reliability, validity, and discriminant validity of the ability evaluation index system, 699 general practitioners from 23 community health service centers in Shanghai were selected by stratified cluster sampling method to participate in the survey. Twenty-five experts were invited to assess the importance of each item in the ability evaluation index system, to determine the weights using the analytic hierarchy process. Results The overall cronbach’s alpha coefficient of the ability evaluation index system was 0.976. Exploratory factor analysis extracted three common factors with a cumulative variance contribution rate of 76.929%. Model fit was performed using Amos 21.0 statistical software,showing that root mean square residual(RMR）=0.044, root mean square error of approximation(RMSEA）=0.077, incremental fit index(IFI）=0.938, comparative fit index(CFI）=0.938, and tacker-lewis index(TLI）=0.932, parsimonious goodness-of-fit index(PGFI）=0.701, parsimonious normed fit index(PNFI）=0.853, parsimonious comparative fit index(PCFI）=0.847, which met the evaluation criteria. The square root values of each factor were greater than the correlation coefficients between this factor and other factors, indicating good discriminant validity of the index system. The weights of knowledge, attitude, and skills in the primary index were 0.454, 0.225 and 0.321, respectively. Conclusion The comprehensive evaluation index system for general practitioners’ ability of psychosomatic medicine service demonstrates good reliability and validity, indicating that it can serve as a tool for the training, evaluation, and assessment of general practitioners’ ability of psychosomatic medicine service.